10 LOOKING AT THE WHOLE PICTURE
Chief clinical officer’s roots are in West Virginia

26 GETTING THE POINT ACROSS

Sonnie Price, the program administrator at Change Health, joined
the staff earlier this year

30 GETTING TO THE ROOTS OF ADDICTION
Dual diagnoses pose challenges

Change Health Systems Magazine
is published by theinfluence.org
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Copyright 2018 by TheInfluence.org.
No part of this publication may be
reproduced in any form or by any
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in magazines or newspapers, or limited
excerpts strictly for personal use.
Printed in the United States of America.
All rights reserved.

54 WORKING TOWARD A POSITIVE
COMMUNITY

Working at Change Health leads to career change

58 WORKING TOWARD A POSITIVE
COMMUNITY

Working at Change Health leads to career change

IN THE NEWS
14 CVS PHARMACY

CVS Health has installed safe medication disposal
units in 19 of its pharmacies across Maryland

CHS provides short-term respite
services to families caring for children
with serious emotional disturbances
or adults with serious and persistent
mental illness. These services give
caregivers a break from the rigors of their
care-giving duties and support the clients in
remaining in their homes. In- home Respite
services may be provided at
the client’s home, school or any other.

Our Psychiatric rehabilitation program which is known as our
â&#x20AC;&#x153;Pathway to Wellnessâ&#x20AC;? program. Our Pathway to Wellness
program caters primarily for adults facing continuous
developmental and behavioral health issues. We also serve
individuals with emotional and/or behavioral challenges. Our
Pathway to Wellness Program provides organized activities to
assist clients in recovery from behavioral health disorders to
develop the emotional, social and intellectual skills needed to live,
learn and work in the community with the least amount of support.
These activities are provided both offsite and on-site. Some of our
Pathway to Wellness services and group topics include:

-Wellness Support-Preparation for employment-Coping with Bereavement and Grief-Money and financial management-Stress Recognition and management-Yoga and Medication-Dance, recreation and exercise-

CVS Health has installed safe medication disposal
units in 19 of its pharmacies across Maryland, in an
effort to help prevent opioid abuse and misuse.
-14-

Maryland is among states across the U.S. that have been ravaged
by the deadly ongoing opioid epidemic. Tom Davis, vice president
of professional services for CVS Health (NYSE: CVS), said CVS
is seeking to support communities that have been affected by
the crisis with its medication disposal kiosks. The units will allow
patients to drop off unused or excess pills from old prescriptions,
so they can be handed over to police and safely disposed of.
“This is for those medications that are sitting in your home that
w
are no longer needed,” Davis said. “So maybe a patient had
a broken leg and needed opioids for the pain, but has some
pills left over — those drugs can be easily diverted for abuse by
anyone who has access, and we want to help prevent that.”
In addition to the medication disposal effort, the CVS Health
Foundation is helping to fund opioid-related efforts at the local
level, by awarding up to $2 million in grants to community health
centers dedicated to supporting opioid addiction recovery. In
Baltimore, a $85,000 grant is going to Total Health Care. The
funding will be used to develop and implement care models
to increase participation in Total Health Care’s substance abuse
treatment program.
Davis said taking part in combating the opioid crisis is in line with
CVS’s mission as a health care company.
“Our pharmacists are uniquely positioned as part of the local
health care systems to play an important role in educating and
also intervening on this issue,” Davis said. “Our mission is about
helping people on their path to better health, and one of the ways
we can do that is through heightened safety around prominent
public health issues.”

[in Maryland] overdose deaths
related to heroin, fentanyl and other
opioids reached a new high of 1,501
I recently returned to Buffalo after living five years in Maryland
where, in the first nine months of 2017, overdose deaths related
to heroin, fentanyl and other opioids reached a new high of 1,501.
In response to a mandate from Gov. Larry Hogan, my colleagues
and I developed an opioid awareness program for all newly
admitted students at Johns Hopkins University. The recent
move by the Town of Tonawanda to equip its police officers with
naloxone moves that department from being aware to taking
action to save lives.
Amid the nation’s opioid crisis, why are communities slow to adopt
the lifesaving antidote naloxone? On April 5, U.S. Surgeon General
Dr. Jerome Adams issued an advisory recommending that more
Americans carry naloxone – not just emergency responders and law
enforcement personnel, but average citizens.
Recent reports from the Centers for Disease Control and Prevention
suggest that more than half of opioid overdose deaths are caused
by synthetic drugs, including fentanyl. While heroin overdoses
evolve in minutes to hours, fentanyl is faster acting and more potent,
evidenced by that overdose evolving in seconds to minutes.
In his study, “Characteristics of fentanyl overdoses – Massachusetts,
2014-2016,” Dr. Alexander Walley reported that among people who
witnessed naloxone being administered, 83 percent said that two or
more naloxone doses were used before the person responded. Of
those who died from fentanyl overdoses, 90 percent had no pulse by
the time emergency medical services arrived.

-19-

-20-

-21-

Patients who wind up in emergency rooms because
of drug use have far more types of drugs in their
systems than the standard screening test used by
hospitals is catching, a new study has found.
-22-

While the drug epidemic has focused on opioid use, two-thirds
of patients who ended up at two University of Maryland Medical
System emergency rooms in 2016 had multiple drugs in their
systems — up to six were found in some urine samples.
Emergency rooms tend to use a basic urine test that, like a
pregnancy test, turns colors when it detects certain chemicals in
drugs. The test is quick and inexpensive, but detects fewer than a
dozen drugs, including opioids. The tests don’t detect drugs such
as fentanyl and oxycodone, both of which have contributed to
record overdoses across the country.
Knowing what drugs a patients has taken can help doctors
better decide a course of immediate treatment, as well as followup treatment such as rehabilitation, said doctors from the two
emergency rooms and researchers from the Center for Substance
Abuse Research at the University of Maryland, College Park.
“We need to know the drug trends to know how to help people,”
said Dr. Zachary D.W. Dezman, an attending physician in the
emergency room at Midtown.
Urine samples were tested from 106 patients at Prince George’s
and 69 from the Midtown campus. Patients in Baltimore tested
positive mostly for marijuana and fentanyl, a highly potent
synthetic often added to heroin without users knowing.

The results highlight the
complexities that exist in
the current epidemic, said
principal investigator Eric
Wish, director of the Center for
Substance Abuse Research. In
some cases, dealers are mixing
drugs without the knowledge
of users. Many of the patients
whose urine was tested
misinformed doctors about
what they had taken.
“It used to be [drug users]
didn’t want to admit what they
were taking,” Wish said. “In
this age they don’t know what
they are taking.”
Maryland’s drug-related deaths
increase for seventh straight
year, reach all-time high in
2017.
“People are like walking drug
stores now, there are so many
drugs in their system,” Wish
said. “A lot of the treatment
now is focused on opioids. The
important thing for the medical
and treatment community to
know is they are using far more
than opioids.”
Lawmakers and public health
officials need to know the
extent of fentanyl use to help
reduce it, he said.
“The emergency room is a
place from which you can
launch those public health
efforts,” he said.

-23-

THERE IS
LIFE AFTER
ADDICTION
-24-

2401 Liberty Heights Avenue Suite 4670
Baltimore, MD 21215

410-233-1088

-25-

GETTING THE

POINT
ACROSS

-26-

-27-

COMMUNITY
BEHAVIORAL
HEALTH
SERVICES
-28-

Board eligible or certified
Psychiatrists are available
for diagnostic assessment
as well as medication
monitoring and evaluation.

Mission:
To empower individuals and promote selfawareness through supportive educational
and therapeutic interventions.

Vision:
To be a partner in facilitating and sustaining
positive community development where all
individuals can attain their full potentials.

Philosophy:
We Believe “Treatment works,” “Change
Begins with me,” and “It’s all personalized.”

2401 Liberty Heights Avenue
Suite 4670
Baltimore MD 21215

410.233.1088
change-health.com

-33-

Addiction is not simply a weakness. People from
all backgrounds, rich or poor, can develop an
addiction. Addiction can happen at any age.
-34-

We can
help you
manage your
addiction...
through
medication
based
treatment and
counseling.
There is hope...
What is addiction and why do
scientists believe it is a treatable disease?

According to the National Institute on Drug Abuse, when a
person can’t stop taking a drug or drinking alcohol even if he/she
wants to, it’s called addiction. The urge is too strong to control,
even if he/she know the drug is causing harm.
When people start using drugs or drinking alcohol, they don’t
plan to get addicted. They like how the drug/alcohol makes them
feel. They believe they can control how much and how often they
take the drug or drink. However, drugs/alcohol change the brain.
People start to need the drug/alcohol just to feel normal. That is
addiction, and it can quickly take over a person’s life.
Drugs/alcohol can become more important than the need to eat
or sleep. The urge to get and use the drug or to drink can fill
every moment of a person’s life. The addiction may replace all the
things the person used to enjoy. A person who is addicted might
do almost anything—even lying, stealing, or hurting people—to
keep taking the drug or drinking alcohol.

-35-

and we’re here
to help.
Addiction is a
brain disease.

• Drugs change how the brain
works.
• These brain changes can last
for a long time.
• They can cause problems like
mood swings, memory loss,
even trouble thinking and
making decisions.
• Addiction is a disease, just
as diabetes and cancer are
diseases.

-37-

Giving addicts
a “reset ”
Developers working on first digital
therapy app for addiction

One reason the opioid addiction epidemic has taken hold in many
rural areas is that many Americans with substance use disorder live
long distances from the nearest treatment providers.
But a new tool may provide hope. The U.S Food and Drug
Administration (FDA) is currently reviewing a new tool that may
help remedy that geographical problem: the first prescription digital
therapy designed to treat SUD.
Boston and San Francisco-based Pear Therapeutics developed
reSET, a mobile app used as a treatment tool concurrently
with outpatient therapy centered on SUDs. The project has
demonstrated better abstinence and treatment retention when
applied alongside face-to-face therapy focused on SUD-related
treatments for alcohol, marijuana, cocaine and stimulants. The
therapy also includes a web-based program for healthcare providers.

An app to help opiate addicts

Pear is also developing reSET-0, an app specifically designed to help
opiate addicts. Both apps consist of a patient-facing smartphone
application and a clinician-facing web interface.
The company raised $20 million last year with the aid of various venture
companies including Arboretum Ventures, an Ann Arbor, Mich.-based
venture capital firm. “(reSET) will give patients and clinicians a new
tool to improve therapy specifically in an area right now that is a true
health epidemic in the U.S,” Dr. Thomas Shehab, managing director at
Arboretum Ventures, told DrugAddictionNow.com. “It’s an extremely
novel approach to central nervous system and behavioral health diseases
that we didn’t see anyone else addressing in that way.”
Brought to you by:

26
-38-

Pear submitted reSET for review
by the FDA during the first half of
2016 and says it is expected to be
approved this year. Dr. Shehab said
his firm is “particularly intrigued
by their approach because it’s a
combination of a very well-studied
digital therapy being used in
conjunction with other therapies.”
He says, “We thought the unique
makeup of the Pear team and
their unique approach to digital
therapies really made us feel it had
the highest likelihood of success in
really helping address these issues.”

According
to data
provided
by Pear
Therapeutics,
people
10 treatment
centers
nationally
According
to data
provided
by Pear
Therapeutics,
507 507
people
withwith
SUDSUD
fromfrom
10 treatment
centers
nationally
received
either
face-to-face
therapy
or
reduced
volume
of
face-to-face
therapy
with
reSET.
They
were
received either face-to-face therapy or reduced volume of face-to-face therapy with reSET. They were givengiven
12 weeks
of outpatient
therapy
or without
the app;
if without,
a portion
of digital
the digital
therapy
12 weeks
of outpatient
therapy
withwith
or without
usingusing
the app;
if without,
a portion
of the
therapy
was was
replaced
face-to-face
therapy.
replaced
withwith
face-to-face
therapy.
Abstinence
calculated
times
weekly
through
a breathalyzer,
samples
self-reports.
Of the
Abstinence
was was
calculated
two two
times
weekly
through
a breathalyzer,
urineurine
samples
and and
self-reports.
Of the
participants
dependent
on
alcohol,
marijuana,
cocaine
and
stimulants,
58.1
percent
of
them
receiving
treatment
participants dependent on alcohol, marijuana, cocaine and stimulants, 58.1 percent of them receiving treatment
reSET
abstinent
during
weeks
through
12, versus
percent
of participants
receiving
withwith
reSET
werewere
abstinent
during
weeks
ninenine
through
12, versus
29.829.8
percent
of participants
receiving
onlyonly
face-to-face
therapy.
face-to-face
therapy.
Of participants
the participants
started
the study
a positive
percent
of them
received
reSET
Of the
whowho
started
the study
withwith
a positive
drugdrug
test,test,
26.726.7
percent
of them
whowho
received
reSET
were
abstinent
during
weeks
nine
through
12
of
the
study;
only
3.2
percent
of
those
that
received
traditional
were abstinent during weeks nine through 12 of the study; only 3.2 percent of those that received traditional
face-to-face
therapy
reported
abstinence
during
the same
period.
face-to-face
therapy
reported
abstinence
during
the same
timetime
period.
Participants
reSET
presented
statistically
significant
advancement
in retention
compared
to those
Participants
usingusing
reSET
presented
statistically
significant
advancement
in retention
ratesrates
compared
to those
not using
the app.
12 weeks,
59 percent
of participants
received
face-to-face
therapy
retained
sobriety
not using
the app.
AfterAfter
12 weeks,
59 percent
of participants
that that
received
face-to-face
therapy
retained
sobriety
in
comparison
to
the
67
percent
of
those
that
used
reSET.
The
reSET-O
app
has
shown
promising
results
in comparison to the 67 percent of those that used reSET. The reSET-O app has shown promising results in in
independent
randomized
clinical
trials,
the company
threethree
independent
and and
randomized
clinical
trials,
the company
says.says.
A study
of 465
participants
completed
outpatient
methadone
A study
of 465
participants
that that
completed
outpatient
methadone
or buprenorphine
treatment
for opioid
addiction
conducted,
or buprenorphine
treatment
for opioid
addiction
was was
conducted,
in
which
the
participants
were
given
standardized
face-to-face
in which the participants were given standardized face-to-face
therapy
or shortened
standardized
treatment
reSET-O.
therapy
or shortened
standardized
treatment
withwith
reSET-O.
TheirTheir
abstinence
determined
by self-reporting
abstinence
was was
determined
by self-reporting
and and
urineurine
tests.tests.
developers
to submit
reSET-O
to FDA
the FDA
for approval,
The The
developers
planplan
to submit
reSET-O
to the
for approval,
pending
approval
of
reSET.
“With
all
that’s
going
on,
pending approval of reSET. “With all that’s going on, this this
is a is a
exciting
company
enthusiastic
about
because
veryvery
exciting
company
that that
we’rewe’re
veryvery
enthusiastic
about
because
it benefits
a group
of patients
in great
need,”
Dr. Shehab
it benefits
a group
of patients
in great
need,”
Dr. Shehab
said.said.
“We“We
think
that
reSET
has
a
lot
of
potential.”
think that reSET has a lot of potential.”

Maker
receives
Maker
receives
NIDA
grant
NIDA
grant

In July,
announced
In July,
PearPear
announced
it it
has received
a Small
Business
has received
a Small
Business
Innovation
Research
(SBIR)
Innovation
Research
(SBIR)
Fast-Track
award
funded
by the
Fast-Track award funded by the
National
Institute
on Drug
Abuse
National
Institute
on Drug
Abuse
(NIDA).
PEAR
will
collaborate
(NIDA). PEAR will collaborate
CleanSlate
Research
withwith
CleanSlate
Research
and and
Education
Foundation
Education
Foundation
and and
Columbia
University
Medical
Columbia University Medical
Center
Department
of Psychiatry’s
Center
Department
of Psychiatry’s
Division
on
Substance
Division on Substance Use Use
Disorders
on project.
the project.
Disorders
on the
support
The The
grantgrant
will will
support
the the
application
of “enhanced
application
of “enhanced
engagement
gamification
engagement and and
gamification
mechanisms”
to reSET
mechanisms”
to reSET
and and
reSET-O,
the company
reSET-O,
the company
says.says.

Hidden
Danger
New synthetic drug strains are making
it difficult to diagnose overdose

-48-

Over the course of two days in mid-August, more than 95 people in New Haven,
Connecticut, overdosed.
Their drug, however, wasn’t heroin. It was synthetic cannabinoids, commonly sold as
K2, Spice, or potpourri.
The fallout from the incident was so widespread that experts have referred to
it as a “mass casualty incident.”
In nearby Baltimore, a new study by the University of Maryland’s
Center for Substance Abuse Research (CESAR) published this month
articulates many of the problems with identifying and treating
synthetic cannabinoid overdoses.
Researchers studied urine samples of patients with suspected
synthetic cannabinoid overdose at two different hospitals, the
University of Maryland Medical Center Midtown Campus in
Baltimore and the University of Maryland Prince George’s
Hospital Center in Cheverly, a suburb of Washington, D.C.
They almost immediately hit a snag with their study.
If the patients had been using Spice, why wasn’t it
showing up in their urine?
“When we got the results back, it was just kind
of amazing because we expected to find a large
percentage testing positive for the synthetic
cannabinoids metabolites we were testing for, and
what we found was that in the first go around only
I think one specimen testing positive for it,” said
principal investigator Eric Wish, PhD, a principal study
investigator and director of CESAR at the University of
Maryland, College Park, College of Behavioral & Social
Sciences.
Despite testing the urine for 169 different drugs,
including 26 metabolites of synthetic cannabinoids, it
simply wasn’t there.
The issue, say experts, highlights an urgent need for
improved testing for so-called new psychoactive substances,
including Spice and synthetic cathinones, also known as bath
salts.
These new drugs don’t show up on standard drug tests, making it
difficult to form a clear diagnosis.
Designer drugs continually manage to dodge legislation because whenever
a certain variety is outlawed based on its chemical structure, a new similar
chemical is manufactured and sold legally.>>>

“While the press and the media talk about Spice and K2
like it’s a single type of phenomenon, the truth can’t be
further from that,” Wish told Healthline. “Basically what
you have is some chemist in another country, oftentimes
the DEA says it’s China, who waits and they see what has
been put on the prohibited list by the government. And
then they go ahead and they tweak the molecule a little
so it’s no longer on the prohibited list and then they make
it available.”
New diagnostic measures
One year later, researchers implemented an updated
drug-test panel that increased the number of synthetic
cannabinoids from 26 to 46.
Even with this improved panel, only about one-quarter of
the samples tested positive.
The study also highlights several other findings that could
potentially help improve immediate care for individuals
overdosing on newer drugs at emergency departments as
well as future public health initiatives.
For instance, where a patient lives can foretell what drugs
may be in their bloodstream.
Researchers saw that in patients at Prince George’s
County. Nearly half of them also tested positive for the
hallucinogen PCP.
Those at the Midtown Campus hospital were far more
likely to have cocaine and fentanyl in their bloodstream.
“The study provides public health officials, provides
patients themselves, an understanding of the risks that
they are exposed to,” said Dr. Zachary D.W.
Dezman, an assistant professor of
emergency medicine at the
University of Maryland
School of Medicine.

-50-

“People want
to know what
they’ve been
exposed to.”

The fentanyl factor
Fentanyl, a powerful synthetic opioid, is increasingly showing up across
the United States with deadly results.
In this study, researchers found that among all substances, fentanyl was
the most likely to be found in combination with multiple other drugs.
In some specimens, it was detected with as many as 12 others —
indicating that users either aren’t aware what is in their drugs or that
users of fentanyl are regularly using many different drugs simultaneously.
People “want to know what they’ve been exposed to,” said Dezman.
“I’ve had a number of patients who once they were told they were
fentanyl positive… started to seek treatment,” he added.
Currently, fentanyl doesn’t show up on common “dip tests” used in
hospitals, but Dezman hopes that will soon change.
Synthetic cannabinoids, fentanyl, and synthetic cathinones represent
a new challenge for members in the healthcare community to identify
and treat, but by understanding which drugs are being used in which
communities, better education and treatment options can be developed.
“We can track people down to a particular area code, and that allows us
to do things like create, potentially, a mobile van for education efforts
to educate the neighborhood on the dangers they are being exposed
to, signs to look out for an opioid overdose, distribute naloxone, and
potentially also start a mobile opioid maintenance therapy van [to
provide] methadone or Suboxone,” said Dezman.

These medications act directly upon the opioid
receptors; more specifically the mu receptors.
Because the effects of these medications vary
at the receptor level, there can be different clinical
effects during treatment.

Buprenorphine

Suboxone | Subutex

A FULL AGONIST binds to the receptor and activates it by
changing its shape - inducing a full receptor response.

A PARTIAL AGONIST binds to the receptor and activates it with
a smaller shape change in the receptor that includes a partial
receptor response.